Inégalités sociales de mortalité au-delà de 65 ans. Le cas de la Belgique

RésuméLes inégalités sociales de mortalité au-delà de 65 ans sont une problématique importante dans le contexte actuel de vieillissement de la population, d’augmentation de l’espérance de vie et de politiques visant à augmenter l’âge légal de départ à la retraite. Cet article pose trois questions : les inégalités sociales face à la mort, très présentes aux âges actifs, se maintiennent-elles durant la vieillesse ? Comment ont-elles évolué au cours de ces dernières décennies ? Quel est le rôle de l’état de santé sur le différentiel social de mortalité aux âges élevés ? Nous utiliserons une base de données appariant les informations du Registre national (1991-2016) avec celles des recensements de la population de 1991, 2001 et 2011. Des tables de mortalité par groupe social et état de santé subjectif ont été calculées et nous aurons aussi recours à des modèles de régression logistique. Les résultats montrent qu’au-delà de 65 ans, les inégalités sociales face à la mort sont importantes et ont même augmenté aux cours des 25 dernières années. En contrôlant l’état de santé, des différences de mortalité subsistent entre les groupes sociaux mais varient en importance en fonction du gradient social. Les plus âgés doivent donc faire l’objet d’une attention particulière, non seulement parce qu’il s’agit d’une population intrinsèquement plus fragile mais aussi parce que leurs effectifs croissent. Il s’agit là d’un défi actuel et futur majeur de santé publique.AbstractSocial inequalities in mortality beyond the age of 65 are an important issue in the current context of population ageing, increased life expectancy and policies aimed at extending the legal retirement age. This article asks three questions: do social inequalities in the face of death, which are very present at working ages, continue in old age? How have they evolved over the last few decades? What is the role of health status on the social differential in mortality at advanced ages? We will use a database matching information from the National Register (1991-2016) with information from the 1991, 2001 and 2011 population censuses. Mortality tables by social group and subjective health status have been calculated. We also use logistic regression models. The results show that social inequalities in the face of death beyond the age of 65 are significant and have even increased over the last 25 years. Controlling for health status, mortality differences remain between social groups but vary in magnitude along the social gradient. The elderly therefore need specialattention, not only because they are an inherently more fragile population, but also because their numbers are increasing. This is a major current and future public health challenge.

Quels territoires de santé gérontologique pour repenser l’adéquation entre offre et besoins d’aides en Wallonie ?

Le vieillissement des populations fait aujourd’hui partie des défis à assumer par les autorités locales et supra-locales. D’après les projections de population, les effets de ce processus risquent même à terme de durcir le débat. Mais les évolutions globales masquent de réelles disparités locales. En Wallonie, l’une des régions administratives de la Belgique avec la Flandre et Bruxelles, il existe d’importantes disparités entre les communes, notamment en ce qui concerne l’ampleur du vieillissement des populations, leur isolement, leur état de santé, mais également la disponibilité d’aides, de soins et de services. C’est sur base de ces constats que cet article a été rédigé, en vue de fournir une réponse à la question de recherche suivante : comment l’offre de soins, de services et d’aides varie-t-elle spatialement et s’adapte-t-elle, ou non, aux besoins des populations âgées ? Plus largement, cet article vise à nourrir la discussion relative à l’existence de bassins ou territoires de santé gérontologique.Today, population aging is one of the most important challenges for local, regional, and national authorities. The consequences of population ageing for elderly care as foreseen by population projections may lead to tense debates in the future. However, global evolutions tend to hide local disparities. Wallonia, one of the Belgian administrative regions along with Flanders and Brussels, shows significant disparities between municipalities particularly as regards to the extent of population aging, the isolation and health of elderly people, and also the availability of care, support and services for the elderly. This paper aims to provide an answer to the following research questions: how does the provision of care, support and services vary across Walloon municipalities? How is it compatible with elderly needs? More broadly, this article aims to stimulate discussion about the existence of gerontological health territories. Data used for this article come from different sources depending on their availability at the local level (National Register, national institute for health insurance, mutual insurance system, etc.). Elderly needs are estimated from local age structures, health indicators, social characteristics and isolation of the elderlies. We also use the availability of formal and informal support to estimate elderly care supply. Our methodology attributes two scores for each Walloon municipality: one for needs and one for care supply. We compare local situations to the regional average level on a scale from 1 to 3 (“1” for higher supply than needed for of older people; “3” for higher needs than available services can provide; “2” refers to the mean score for Wallonia) – See map below-. According to our analysis the care supply does not meet everywhere the needs of the elderlies. Several dichotomies are observed in Wallonia mainly between the north and the south of the region but also between urban, suburban, and rural areas. Walloon Brabant and the South of the province of Luxembourg are areas where needs are low and/or supply is higher than in the rest of the Wallonia. On the contrary, the South of the Wallonia is mainly rural where needs are higher than elsewhere. To note, these areas are attractive for the elderly who migrates after leaving the labor market. Despite higher needs, those rural areas are geographically isolated and the gap between elderly care supply and needs is more important than elsewhere. This is also the case for municipalities in former industrial areas. There, the gap is mainly explained by higher fragility of older people that sometimes hold concomitantly bad health and poor socioeconomic conditions

La fécondité des migrantes internes en Belgique

Résumé Cette étude propose d’une part, une analyse spatiale de l’évolution de la fécondité en Belgique au cours du 20ème siècle et, d’autre part, une étude des effets de la migration sur la fécondité. L’exploitation des données individuelles et rétrospecti­ves des recensements de la population de 1981 et de 2001, nous a permis de reconstituer la vie génésique complète des générations de femmes nées entre le dé­but du 20ème siècle et les années 1960. Nous avons d’abord testé la pertinence d’une approche rétrospective dans le cadre d’une analyse spatiale de la fécondité. En effet, alors que le lieu de résidence des femmes est défini à la date du recensement, elles ont pu donner naissance ailleurs ; dans ce cas, les indicateurs spatiaux de fécondité (par exemple, la descendance finale par commune) calculés par cette approche rétrospective pourraient être biaisés. Néanmoins, les tests de validation que nous avons menés démontrent que ce biais est insignifiant. Ensuite, nous avons analysé l’impact de la migration sur la fécondité, en comparant les comportements de fécondité des migrantes (les femmes qui ont changé de type de commune) et des non-migrantes. Les comportements de fécondité des femmes se con­forment plutôt à ceux pratiqués au lieu de destination qu’au lieu d’origine. Les ré­sultats vérifient davantage les hypothèses d’adaptation et de sélection que celle de la socialisation. Summary This study investigates the spatial dimension of fertility evolution in Belgium during the 20th century, and in particular the effect of migration on fertility. Based on the 1981 and 2001 Belgian Censuses data at the individual level, we use a retrospective approach in order to reconstitute complete fertility histories of women born between the early 20th century and the 1960’s. The first part of the article tests the relevance of a retrospective approach for spatial analysis. In fact, whereas the women’s place of residence is defined at the census date, they could have experienced their childbearing elsewhere; therefore, spatial fertility indicators (e. g. total fertility by municipality) calculated by a retrospective approach could be biased. However, our validation tests show that such bias is irrelevant. In the second part, we investigate the impact of migration on fertility. We compare fertility behaviour of migrants (i. e. women who changed municipality types) and non-migrants. Results suggest that migrants’ fertility behaviour is closer to the dominant behaviour at destination than to that at origin, which rejects socialisation hypothesis while supporting the adaptation or selection hypotheses

Diversités démographiques et migrations résidentielles dans les espaces ruraux en Wallonie (Belgique)

Sur base d’un ensemble d’indicateurs sociaux, économiques, environnementaux… et en utilisant des méthodes statistiques d’analyse en composantes principales et de classification, six types d’espaces ruraux ont pu être distingués en Wallonie. L’objectif était de vérifier si ces types d’espaces ruraux présentent des paramètres et des dynamiques démographiques particuliers. Les résultats ont démontré que l’univers rural wallon est marqué par la diversité des caractéristiques (répartition par âge, structure des ménages) et des comportements (mortalité, fécondité, migrations) démographiques. Certaines différences significatives, en termes de longévité ou encore d’importance relative de ménages monoparentaux, reflètent des inégalités sociales importantes et souvent insoupçonnées. Les migrations constituent le moteur de la démographie locale. Elles contribuent très largement à la croissance de la population des espaces ruraux wallons et, par leur sélectivité selon l’âge et le type de ménage, elles renforcent les contrastes sociodémographiques entre ceux-ci.On a basis of a set of social, economic and environmental indicators, and by using multivariate analysis, six types of rural spaces have been distinguished in Wallonia. The objective was to check if these types of rural spaces convey particular demographic profiles and trends. The results show indeed that the Walloon rural area is rather heterogeneous as regards characteristics such as age and household distributions; and demographic behaviours (mortality, fertility, migrations). Some significant differences, in terms of longevity or from the relatively high proportion of single-parent households, reflect important and often unsuspected social disparities. This paper also demonstrates that on local scale, and in a context of land pressure with saturated real estate markets, migrations contribute to increase stronger social and demographic disparities within rural areas in Wallonia

LoCuSS: First Results from Strong-lensing Analysis of 20 Massive Galaxy Clusters at z~0.2

We present a statistical analysis of a sample of 20 strong lensing clusters drawn from the Local Cluster Substructure Survey (LoCuSS), based on high resolution Hubble Space Telescope imaging of the cluster cores and follow-up spectroscopic observations using the Keck-I telescope. We use detailed parameterized models of the mass distribution in the cluster cores, to measure the total cluster mass and fraction of that mass associated with substructures within R<250kpc.These measurements are compared with the distribution of baryons in the cores, as traced by the old stellar populations and the X-ray emitting intracluster medium. Our main results include: (i) the distribution of Einstein radii is log-normal, with a peak and 1sigma width of =1.16+/-0.28; (ii) we detect an X-ray/lensing mass discrepancy of =1.3 at 3 sigma significance -- clusters with larger substructure fractions displaying greater mass discrepancies, and thus greater departures from hydrostatic equilibrium; (iii) cluster substructure fraction is also correlated with the slope of the gas density profile on small scales, implying a connection between cluster-cluster mergers and gas cooling. Overall our results are consistent with the view that cluster-cluster mergers play a prominent role in shaping the properties of cluster cores, in particular causing departures from hydrostatic equilibrium, and possibly disturbing cool cores. Our results do not support recent claims that large Einstein radius clusters present a challenge to the CDM paradigm.Comment: 28 pages, 14 figures, accepted for publication in MNRAS, replaced with accepted versio

LoCuSS: A Comparison of Sunyaev-Zel'dovich Effect and Gravitational Lensing Measurements of Galaxy Clusters

We present the first measurement of the relationship between the Sunyaev-Zel'dovich effect signal and the mass of galaxy clusters that uses gravitational lensing to measure cluster mass, based on 14 X-ray luminous clusters at z~0.2 from the Local Cluster Substructure Survey. We measure the integrated Compton y-parameter, Y, and total projected mass of the clusters (M_GL) within a projected clustercentric radius of 350 kpc, corresponding to mean overdensities of 4000-8000 relative to the critical density. We find self-similar scaling between M_GL and Y, with a scatter in mass at fixed Y of 32%. This scatter exceeds that predicted from numerical cluster simulations, however, it is smaller than comparable measurements of the scatter in mass at fixed T_X. We also find no evidence of segregation in Y between disturbed and undisturbed clusters, as had been seen with T_X on the same physical scales. We compare our scaling relation to the Bonamente et al. relation based on mass measurements that assume hydrostatic equilibrium, finding no evidence for a hydrostatic mass bias in cluster cores (M_GL = 0.98+/-0.13 M_HSE), consistent with both predictions from numerical simulations and lensing/X-ray-based measurements of mass-observable scaling relations at larger radii. Overall our results suggest that the Sunyaev-Zel'dovich effect may be less sensitive than X-ray observations to the details of cluster physics in cluster cores.Comment: Minor changes to match published version: 2009 ApJL 701:114-11

The SOS-framework (Systems of Sedentary behaviours): an international transdisciplinary consensus framework for the study of determinants, research priorities and policy on sedentary behaviour across the life course: a DEDIPAC-study.

BACKGROUND: Ecological models are currently the most used approaches to classify and conceptualise determinants of sedentary behaviour, but these approaches are limited in their ability to capture the complexity of and interplay between determinants. The aim of the project described here was to develop a transdisciplinary dynamic framework, grounded in a system-based approach, for research on determinants of sedentary behaviour across the life span and intervention and policy planning and evaluation. METHODS: A comprehensive concept mapping approach was used to develop the Systems Of Sedentary behaviours (SOS) framework, involving four main phases: (1) preparation, (2) generation of statements, (3) structuring (sorting and ranking), and (4) analysis and interpretation. The first two phases were undertaken between December 2013 and February 2015 by the DEDIPAC KH team (DEterminants of DIet and Physical Activity Knowledge Hub). The last two phases were completed during a two-day consensus meeting in June 2015. RESULTS: During the first phase, 550 factors regarding sedentary behaviour were listed across three age groups (i.e., youths, adults and older adults), which were reduced to a final list of 190 life course factors in phase 2 used during the consensus meeting. In total, 69 international delegates, seven invited experts and one concept mapping consultant attended the consensus meeting. The final framework obtained during that meeting consisted of six clusters of determinants: Physical Health and Wellbeing (71% consensus), Social and Cultural Context (59% consensus), Built and Natural Environment (65% consensus), Psychology and Behaviour (80% consensus), Politics and Economics (78% consensus), and Institutional and Home Settings (78% consensus). Conducting studies on Institutional Settings was ranked as the first research priority. The view that this framework captures a system-based map of determinants of sedentary behaviour was expressed by 89% of the participants. CONCLUSION: Through an international transdisciplinary consensus process, the SOS framework was developed for the determinants of sedentary behaviour through the life course. Investigating the influence of Institutional and Home Settings was deemed to be the most important area of research to focus on at present and potentially the most modifiable. The SOS framework can be used as an important tool to prioritise future research and to develop policies to reduce sedentary time